KIN 424 Pollution 2024 PDF

AIR POLLUTION Health Effects of air pollution and exercise Chronic Acute Performance Effects of air pollution and exercise Personal Strategies to reduce impact of air pollution Cases Paris 2024 Guidance Why is Air Pollution Relevant to Climate Change? Air Pollution ≠ Greenhouse Gases More frequent h...

AIR POLLUTION Health Effects of air pollution and exercise Chronic Acute Performance Effects of air pollution and exercise Personal Strategies to reduce impact of air pollution Cases Paris 2024 Guidance Why is Air Pollution Relevant to Climate Change? Air Pollution ≠ Greenhouse Gases More frequent heat waves – ground level ozone Wildfire frequency and severity – Particulate Matter May 2018 October 2022 Case 1 …there has been some concern about the air quality and it's potential health impact on the athletes… …this morning at 9am was 112ug/m3 and that is rated "Unhealthy for Sensitive Groups". The forecast is for the AQI to move to "Unhealthy" tomorrow and to hover there for most of next week… …the marathon and race walk events …are all occurring at night with start times either 11:30pm or 12am … …some staff are concerned that we are placing our athletes at serious health risk by allowing them to compete in these events… Case 2 Tokyo Olympic Games Temperatures >30 C (mean 32.2C) with humidity ~70% Generally lower levels of particulate matter especially at night Highest ozone levels in the OECD – Games held during peak ozone season The Problem with Intense Exercise Exercise and Inhaled Pollution ↑ Minute Ventilation Exercise Nasal → Oral Breathing ↑ Effects of Air Pollution? Air Pollution Inhalation ↑ Deposition in the Lungs ↑ Pulmonary Diffusion Capacity Giles, LV, & Koehle, MS. Sports Med. 2014;44(2):223-249. What are the health effects of dessert? Air Pollution Recipe Gases Ozone, carbon monoxide, oxides of nitrogen (NO2, NO), etc. Particles Solid particles, or liquid droplets like dust, metal, black carbon, pollen What is the Canadian recipe? Wildfires = PARTICULATE MATTER Heat Dome = OZONE Air Pollution and Exercise Matrix Health Performance Acute Exposure studies, Laboratory, Real-world Exposure studies, observational studies Chronic Epidemiological Studies Observational studies Research Models Real World Acute Exposures Realistic pollution exposures Tough to generate control exposures, with blinding Good Pollution Recipe Images: Andy Hung MSc Research Models Laboratory Acute Exposures Controlled consistent pollution exposure Sham condition, blinding crossover design Lack of long-term results Approximate Recipe Images: Luisa Giles, PhD Research Models Real World Epidemiology Studies Long-term results Large sample sizes Control groups and blinding lacking Confounders Good Pollution Recipe Research Models Hybrid Laboratory/Ambient Model Real world pollution exposure Sham condition, blinding crossover design Lack of long-term results Surrogate outcomes UBC Research: Diesel Exhaust during rest and exercise Ozone during rest and exercise Healthy individuals, and those with exercise-induced bronchoconstriction 35 Sample Outcomes 30 25 20 15 10 5 0 -5 -10 1 2 Baseline 20 min 40 3min 60 4min 1055min 1656min Seated in Exposure Booth 20 15 10 5 0 -5 -10 35 30 30 15 10 5 0 -5 -10 1 Baseline 20 2min 3 40 min 60 4min Seated in Exposure Booth Time 1055 min 1656min Post Cycle Bout 20 2min 3 40 min 4 60 min Seated in Exposure Booth 35 20 Diesel Exhaust (DE) 25 Post Cycle Bout 25 Fitlered Air 30 1 Baseline FVC (% change from baseline) FVC (% change from baseline) Performance Lung function Dyspneoa Vascular function Cardiac function FEV1 (% change from baseline) FEV1 (% change from baseline) 35 1055min 6 min 165 Post Cycle Bout 25 20 15 10 5 0 -5 -10 Baseline 20 min 40 min 1 2 3 60 4min Seated in Exposure Booth Time 105 min 165 min 5 6 Post Cycle Bout Air Pollution and Exercise Chronic Health Effects Health Effects of Air Pollution 4.2 Million deaths/year – predominantly LMIC Cardiovascular Ischaemic heart disease and stroke Respiratory Chronic Obstructive Pulmonary Disease And Lower Respiratory tract Infections (18%) Lung Cancer (6%) Diabetes Increased incidence of Type 2 Diabetes Mellitus with PM2.5 exposure ~10% Cognitive Associated with decreased cognitive function and dementia n = 52061 healthy, aged 50-65 ~13 years followup Self-reported physical activity – sports, cycling, gardening NO2 estimated by GIS Outcome was mortality – All cause – Cause-specific (Cancer, CV, respiratory) Inverse association with PA – despite NO2 levels n = 66820, > 65 years 12 years follow-up Self-reported physical activity PM2.5 estimated by satellite Cardiovascular and respiratory mortality Inverse association with PA Positive association with PM2.5 n = 156,314, > 18 years 16 years follow-up Self-reported physical activity PM2.5 estimated by satellite Incidence of Type 2 diabetes mellitis Inverse association with PA Positive association with PM2.5 No interaction between PA and PM2.5 PA helps prevent T2DM even in moderately polluted areas n = 35562 > 60 years 16 years follow-up Wearable accelerometers to assess physical activity (ACCavg) NO, NO2, PM10, PM2.5-10, PM2.5, BC estimated by land use regression models Incidence of dementia death or hospital admission Inverse association with PA Positive association with PM2.5 Black Carbon and PM2.5 reduce beneficial effect of PA Chronic Health Effects Summary AIR POLLUTION = BAD EXERCISE = GOOD Air Pollution and Exercise Acute Health Effects Recent systematic review Focus on acute effects of exercise in air pollution Moderate-to-vigorous physical activity 27 8 Traffic-related air pollution High in particulates Acute Health effects of exercise are somewhat equivocal Performance Effects are equivocal 29 Ozone Effects Consistent worsening of lung function (FVC, FEV1, FEF25-75) Consistently increases symptoms Cough and dyspnoea When O3 levels higher than ~120ppb Increased inflammatory markers (IL-6, neutrophils) 30 Traffic-related Air pollution - TRAP Inconsistent effect on: Lung function Exercise response Symptoms Inflammatory responses Cardiovascular responses Likely increase in blood pressure Heart rate variability and endothelial function unclear 31 Diesel Exhaust (DE) Effects No effect on lung function or heart rate variability Inconsistent effect on symptoms Small effect in one study No real effect of exercise intensity Acute Health Effects Summary Ozone Lung function Symptoms Particulate air pollution Less consistent acute health effects Performance Effects Performance Effects: Ozone Ozone Consistent decrease in VO2max during exercise in ozone Consistent increased symptoms could affect performance Decreased athletic performances at track meet when O3 levels are higher Performance Effects- Particulate Systematic Review unclear effects of TRAP on performance Diesel Exhaust 300 ug/m3 PM2.5 P o w e r o u tp u t (W ) 250 150 100 F ilte re d HR, VO2, RPE P o llute d 300 P o w e r o u tp u t (W ) Ambient Sao Paulo TRAP 50k time trial 200 F ilte re d P o llu te d 250 200 150 0 10 20 30 D ista n c e 40 50 Performance Effects: Football TSG Hoffenheim-Bundesliga Dr. Adam Beavan “AQI was a significant positive predictor of errors and interceptions, indicating increased errors and interceptions with decreased air quality.” Performance Effects Summary Ozone Decreased VO2max during exercise Decreased running performance Symptoms increased Particulate air pollution inconsistent performance effects Possible technical effects in skill-based sports Possible increased RPE, symptoms Possible increased HR and metabolic cost Monitoring/Forecasting weather.gc.ca / Plume App Air Pollution Location When should I train? Canceled: UBC Sports Med What about exercise intensity? Performance Effects - Diesel Diesel Exhaust Exposure study Healthy males 30 min cycling Increased perceived effort At low intensity, increased oxygen cost No effect on heart rate, blood vessel function, lung function, inflammatory markers Giles et al. 2012, Giles et al. 2016 Can we adapt to pollution? 668,277 performance outcomes from 85,000 athletes competing at ~1,700 outdoor collegiate track and field meets QZONE ADAPTATION AND WORK 963 PERFQRMANCE Can we adapt to pollution? ft: +20 5 Adaptation - Ozone 5 ii Id 0 ClE w n / +10 Cl q FR m VT 0 -10 ! \ Stay tuned… A 1 FA I I 0.35 PPm FIG. of initial observed frequency; // 03 /I I I I LdayREPEATED I I day 2 DAILY I I day 3 EXPOSURE 2. Percent change in exercise ventilatory pattern and repeated O3 exposure. Values are calculated at 50th min compared with those at 10th min. VT, tidal volume; FA, filtered air. I I day 4 T O 0.35ppm Cl3 1 as a function from changes fR, respiratory FA 0.35 day 2 PPm03 significantly different from FA following 1, 2, and 3 days of repeated exposure for both fR and VT, whereas only VT remained different after day 4. As indicated in Table 2, differences between lOth- and 50th-min values across all six exposures for VE and HR failed to reach statistical significance (F c 1.46), although 4th-consecutive-day (Foxcroft, V& responses were significantly different from1986) FA and 3rd-consecutive-day values. Pulmonary function response. Percent changes in pul- 1050 1260 ppm-L REPEATED day 3 ppm-L DAILY EXPOSURE T O 0.35 ppm 0, 3. Percent change in pulmonary function on initial exposure and as a result of 4 consecutive days exposure to 0.35 ppm OS. See text for definitions and additional details. FIG. TABLE 3..Results of ANOVA and posterior tests of mean differences of pulmonary function parameters Variable F Ratio Posterior Significant Test Results; Specific Mean Differences What about pre-event air pollution? Diesel Exhaust Pre-exposure Masks 2-hour walk 15 young adults Ambient (Beijing) air 24-hour blood pressure and heart rate variability Langrish, JL, et al. Part Fibre Toxicol. 2009;6:8. What about my inhaler? Doesn’t it open up my lungs? Ozone and diesel exhaust Use as directed What about nutrition? 8 km time-trial run 9 runners Ozone chamber Daily 100 IU vitamin E and 500 mg vitamin C for 2 weeks Gomes, EC, et al. Scand J Med Sci Sports. 2011;21(6):e452-60. Exercise bouts during summer 38 young cyclists Ambient (Netherlands) air Daily 100 mg vitamin E and 500 mg vitamin C for 15 weeks Lung function before and after exercise bout Grievink, L, et al. Am J Epidemiol. 1999;149(4):306-14. 500mg 100mg vitamin E What about training indoors? On high pollution days Limit outdoor air infiltration Clean indoor air with filters cbc.ca Competition Recommendations for primarily PM/TRAP Avoid pollution as much as possible pre- competition Travel to and from competition Consider masks that filter particulate in very high pollution environments Stabilize asthma and exercise-induced bronchoconstriction with medications and proper warm-up Reassurance on performance Minimal performance effects during competition Competition Recommendations - Ozone Avoid pollution as much as possible pre- competition Travel to and from competition Stabilize asthma and EIB with medications and proper warm-up Anticipate symptoms: chest tightness, dyspnoea Some evidence that anti-oxidants may decrease ozone effects 2 weeks of: Vitamin C 250-500 mg OD Vitamin E 100 mg OD (150 IU) Adaptation? Case 1 …there has been some concern about the air quality and it's potential health impact on the athletes… …this morning at 9am was 112ug/m3 and that is rated "Unhealthy for Sensitive Groups". The forecast is for the AQI to move to "Unhealthy" tomorrow and to hover there for most of next week… …the marathon and race walk events …are all occurring at night with start times either 11:30pm or 12am … …some staff are concerned that we are placing our athletes at serious health risk by allowing them to compete in these events… Case 1 Athletes minimised pollution exposure during the day – Did not use masks when outdooprs, but this may have been an option Athletes did pre-event training in late evening when the pollution levels were lowest Reassurance on health risks Athletics Canada had an excellent campaign with many PRs in Doha, partially due to their strategies around heat. Case 2 Tokyo Olympic Games Temperatures >30 C (mean 32.2C) with humidity ~70% Generally lower levels of particulate matter especially at night Highest ozone levels in the OECD – Games held during peak ozone season Case 2 Key long distance events moved to early am 6 am and 7 am starts Prior to ozone Record performances in women’s marathon (9,13) and men’s 50 km race walk (3) Case 3 Canada Men’s National Team 2022 FIFA World Cup qualification (CONCACAF) Top three teams qualify for 2022 WC Finals Canada vs. Top-ranked Mexico 7 October 2021 Case 3 - Azteca Stadium - 2200m High levels of ozone High levels of particulate matter What are the health risks? What are the performance implications? How to prepare? Case 3 Resolution Adapt training design to ease players into the training intensity at the altitude and adapt to ozone Adjust the menus to have more iron-rich and omega-3 food, as well as an emphasis on antioxidant in particular Tart Cherry Juice supplementation to reduce inflammation from training and the game Reassurance re: particulate matter effects on performance Monitor hydration daily to provide players with feedback and additional electrolytes (NUUN) Screening players 6 weeks in advance for iron deficiency and provide supplements Identified two players who played 90 and 75 min post-supplementation Payback 2-1 Canada Take Home Messages Air Pollution is BAD 24 hours per day, 7 days per week Avoid as much as possible Exercise is GOOD Health effects not reduced by air pollution Consider the Recipe! Canada – Wildfires & Ozone